Dec. 13—The Obama administration gave enrollees another month to pay premiums on marketplace plans, which are needed for the coverage to go into effect.

The U.S. Department of Health and Human Services (HHS) announced on Dec. 12 new requirements for insurers offering plans in the marketplaces, or exchanges, created by the Affordable Care Act (ACA) accept payment through Dec. 31 for coverage that begins Jan. 1. HHS also asked insurers to voluntarily extend the premium due dates even further.

Another change extended coverage through the federal Pre-Existing Condition Insurance Plan (PCIP) another month past its planned expiration date to Jan. 31, 2014. That program, also created by the ACA, provided insurance to people with costly pre-existing conditions who were unable to find coverage on the individual market. 

The administration also formalized a previously announced decision to give marketplace enrollees another week after a previous Dec. 15 deadline to enroll in plans and have them effective Jan. 1. Lapses in coverage could expose them to health-related financial liabilities and expose them to penalties under the ACA’s individual coverage mandate.

The administration also sought to address providers’ growing concerns with the proliferation of narrow network plans under the ACA marketplaces by “strongly encouraging” insurers to treat out-of-network providers as in-network in both “acute episodes” and if the provider was listed in their plan’s provider directory at the start of an enrollee’s coverage.

The administration also was “strongly encouraging” insurers to refill prescriptions in January that were covered under enrollees’ previous plans.

“We are providing additional flexibility to consumers across the country to ensure they have access to coverage options that begin on January 1, 2014,” HHS Secretary Kathleen Sebelius said in a release. “The department is committed to providing consumers with the information they need to pick the coverage option that works for them and their families.”

Insurers, Providers Impacted

Health policy experts said the many insurance rule changes and administration requests demonstrate the extent to which enrollment problems due to technical failing of marketplace websites have slowed expected enrollments and left millions of people facing an inability to get coverage before the New Year.

The exchanges have struggled to enroll not only the seven million uninsured expected to obtain coverage in the first open enrollment period, but also many of the five million people whose coverage was cancelled due to the law’s requirements.

The new regulations “promise massive headaches for insurers, providers, and consumers as consumers attempt to access care in January and providers try to figure out whether patients are covered or not, and by whom,” Tim Jost, an attorney expert on the Affordable Care Act, said in a Health Affairs blog post. “They pose some threat of adverse selection as consumers may delay paying their premiums until they are certain they need coverage, but given the short time period for payment and the high deductibles that most consumers will face, this should be a minor consideration.”

Karen Ignagni, president and CEO of America’s Health Insurance Plans said in a release that “with only weeks to go before coverage begins, continued changes to the rules and guidance could exacerbate the challenges associated with helping consumers through the enrollment process.”

Publication Date: Friday, December 13, 2013